North Korean children continue to face significant nutritional challenges according to UNICEF’s 2012 nutritional survey. The survey was carried out in September and October by teams from the Central Bureau of Statistics and the Institute of Child Nutrition trained by an international consultant hired by UNICEF and assisted by local physicians. Data management was carried out by the CBS. Readers can apply their personal subjective discount rate to these results given this set-up and the problematic past history of survey data collection in the DPRK.

The report is transparent about possible sources of survey bias:

There were acknowledged problems in obtaining a proper sample for Ryanggang province;

The final selection of children for sampling was done by local village leaders and could have been subject to a variety of biases of unknown magnitude and direction;

The sample period coincided with the end of the harvest and the measurements may have provided an upwardly biased indication of nutritional status in prior months or some annual average;

And although not acknowledged as a source of potential bias per se, mothers with moderately and severely malnourished children were given dietary supplements, which could have incentivized the village elders to choose children appropriately.

With these caveats, the survey paints a dismal picture. Focusing on the height-for-age measure, a long-term indicator relatively unaffected by seasonal nutritional swings, nearly 10 percent of this generation appears to be severely stunted. Although the overall average for the sample is only 7.2 percent, the incidence of stunting accumulates through the successive age cohorts until reach a peak of roughly 10 percent at age 2. At this age, stunting is irreversible and confers a lifelong set of physical and mental challenges that are passed on intergenerationally.

Ryanggang, which is both isolated and the one case where acknowledged sampling issues were encountered, is the worst affected province with an overall stunting rate of more than 12 percent (implying a peak rate for 2 year olds that is even higher). The next highest rate is Jagang province (9.8 percen) followed by South Hamgyong (9.4 percent). As could be expected, the privileged capital city of Pyongyang is on the other extreme, with a severe stunting rate of only 4 percent. In nearly all the nutritional indicators reported in the report, Ryanggang scores the worst, with South Hamgyong also scoring badly, and specifically scoring worse than neighboring North Hamgyong. The low scores for Ryanggang, the sort of the Appalachia of North Korea, can be rationalized by its isolated rural population, but not so South Hamgyong. Moreover, it is notable that South Hamgyong does worse than North Hamgyong which is farther from Pyongyang—but closer to China.